P1209Secondary stroke prevention in national observational cross-sectional registry of patients with non-valvular atrial fibrillation

Abstract

Background: Stroke prevention in patients (pts) with non-valvular atrial fibrillation (NVAF) is one of the most important clinical goals. Pts who have already suffered from stroke form special subgroup that needs more intensive medical care and best effective stroke prevention. Despite of the high level of evidence from randomized trials, we do not know enough how these pts are managed in the real-world. Purpose: of our study was to evaluate clinical characteristics and real-world stroke prevention strategies in the subgroup of pts with NVAF that survived cardioembolic stroke. Methods: All consecutive pts with NVAF that visited 150 out-patient cardiology clinics were included into national observational cross-sectional registry. Epidemiologic parameters, clinical profile and stroke prevention strategies were evaluated in stroke survivors and in pts without any stroke history. Results: In 10 days, 1975 consecutive pts with NVAF were included into this crosssectional registry. Subgroup of 333 pts (16.9%) suffered from 393 strokes that were managed by thrombolysis or thrombectomy in 42 cases (10.7%). In 142 pts (42.6%) AF has not been detected before the stroke, thus cardioembolism was the first manifestation of NVAF. Other 90 pts (27%) with previously documented AF that fulfilled the ESC criteria for oral anticoagulation did not take any anticoagulants at the time of stroke. Pts who suffered from stroke were significantly older [74.7 6 9,4y vs. 71.5 6 10,1y, p<0.001] 56.4% of them were 75y old vs. only 41.2% pts in pts without any stroke in the history (p<0.001). More pts with previous stroke had permanent AF [45.9% vs. 36.7%, p=0.002] myocardial infarction [14.4% vs. 9%, p=0.004]; heart failure NYHA 2 [33% vs. 27%, p=0.025] and abnormal renal function [27.9% vs. 19.7%, p=0.001]. Mean CHA2DS2Vasc score was significantly higher in stroke survivors [6.1 vs. 3.6, p<0.001] as well as HAS-BLED score [3.1 vs. 1.8, p<0.001]. Oral anticoagulation received 91.6% of pts (84.6% NOAC preference) after the stroke in contrary to 80.8% of pts (48.7% NOAC preference) (p<0.001) without any previous stroke. In the subgroup of stroke survivors, criteria for NOAC dose reduction were met in 50% of pts on dabigatran, 63.8% of pts on rivaroxaban and 18.8% of pts on apixaban. Among patients after stroke, for dose reduction were paradoxically selected pts with higher CHA2DS2Vasc score irrespective of the HAS-BLED score. Conclusion: Results from our cross-sectional national registry pointed out that intensive screening for AF and appropriate anticoagulation is most important in the prevention of stroke. Comorbidities are more frequent and stroke risk significantly higher among the real-world stroke survivors. Further education is essential because implementation of ESC guidelines on anticoagulation for stroke prevention is insufficient even in the subgroup of pts who suffered from stroke.